Team up with Biofloral! Would you like to take advantage of a one-stop shop and find the largest selection of products available on the market? Team up with Biofloral! Please confirm your interest by completing the form below. A member of our customer service team will gladly contact you as soon as possible. BioFloral West : Account opening Biofloral GENERAL INFORMATION Company name * Date * Billing address * City * Province * Choose an option AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal code * Phone * Years in business * PST # GST # HST # Type of company * Choose an option Licenced ProducerLicenced Producer (micro)Store (Point of sale)Online storeAgricultural producersOther Specify * Pesticide permit # Expiry date Please submit the following documents: Upload Pesticide license Drop a file here or click to upload Choose file Maximum file size: 8.39MB Upload Business License Drop a file here or click to upload Choose File Maximum file size: 8.39MB Upload GST Tax Certificate Drop a file here or click to upload Choose File Maximum file size: 8.39MB Upload PST Tax Certificate Drop a file here or click to upload Choose File Maximum file size: 8.39MB Upload Certificate of incorporation Drop a file here or click to upload Choose File Maximum file size: 8.39MB Email for invoices * Name of Accounts Payable Manager * Email of Accounts Payable Manager * How many email addresses would you like to subscribe to our newsletter and promotional updates? * 012345 Email # 1 Email # 2 Email # 3 Email # 4 Email # 5 How many web access codes are required for placing online orders? * 12345 User #1 Name and family name * Email for web access * User #2 Name and family name * Email for web access * User #3 Name and family name * Email for web access * User #4 Name and family name * Email for web access * User #5 Name and family name * Email for web access * FOR LICENSED PRODUCERS ONLY Name of production manager Email Phone License # with Health Canada DELIVERY ADDRESS Same as billing address? * Yes No Address * City * Province * Choose an option AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code * Phone * DELIVERY INFORMATION BUSINESS HOURS Closed at lunchtime? * Yes No From: * 000102030405060708091011121314151617181920212223 : 0030 To: * 000102030405060708091011121314151617181920212223 : 0030 Sunday From: 000102030405060708091011121314151617181920212223 : 000510152025303540455055 To: 000102030405060708091011121314151617181920212223 : 000510152025303540455055 Monday From: * 000102030405060708091011121314151617181920212223 : 000510152025303540455055 To: * 000102030405060708091011121314151617181920212223 : 000510152025303540455055 Tuesday From: * 000102030405060708091011121314151617181920212223 : 000510152025303540455055 To: * 000102030405060708091011121314151617181920212223 : 000510152025303540455055 Wednesday From: * 000102030405060708091011121314151617181920212223 : 000510152025303540455055 To: * 000102030405060708091011121314151617181920212223 : 000510152025303540455055 Thursday From: * 000102030405060708091011121314151617181920212223 : 000510152025303540455055 To: * 000102030405060708091011121314151617181920212223 : 000510152025303540455055 Friday From: * 000102030405060708091011121314151617181920212223 : 000510152025303540455055 To: * 000102030405060708091011121314151617181920212223 : 000510152025303540455055 Saturday From: 000102030405060708091011121314151617181920212223 : 000510152025303540455055 To: 000102030405060708091011121314151617181920212223 : 000510152025303540455055 Tailgate * If you don't have a loading dock or a forklift, you will need a hydraulic tailgate on delivery. Yes No Is the site accessible by a 53-foot trailer all year? * Yes No * Charges may apply Appointment required for delivery? * Yes * Charges may apply No Comments: The customer agrees to follow the terms and conditions in force at Biofloral (terms of payment, credit, delivery, return of goods, etc.) All goods are payable in accordance with the terms and conditions. Electronic signature * By entering your name here, you agree to use an electronic signature and agree that this has the same legal value as a handwritten signature. BANK REFERENCES Name of the bank * Address * Phone * Contact person * SUPPLIERS’ REFERENCES 3 references requested Company * Contact * Phone * Company * Contact * Phone * Company * Contact * Phone * OVERDUE ACCOUNTS Payment is due net 30. Interest of one percent (1%) per month, twelve percent (12%) per year will be added to amounts due after 31 days. All unpaid merchandise remains the property of Biofloral until payment is completed. The place of the contract shall be Pitt Meadows, British Columbia, and governed by its laws. Account privileges may be suspended without notice should the account purchases be past due or in default, in whole or part, at any time. By signing this form, I authorize Biofloral to obtain or exchange information with any information agent or credit company for reference and credit checks. Electronic signature * By entering your name here, you agree to use an electronic signature and agree that this has the same legal value as a handwritten signature. PERSONAL GUARANTEE I, the undersigned, hereby stand jointly and severally surety for the company mentioned above for the respect and fulfillment of all its obligations including if applicable, the reimbursement or payment of any sum of money, in capital, interest and fees) to Biofloral In connection with this contract, I expressly waive the benefits of division and discussion. Guarantor's name Guarantor's home address ID – Driver License Drop a file here or click to upload Choose File Maximum file size: 8.39MB Electronic signature By entering your name here, you agree to use an electronic signature and agree that this has the same legal value as a handwritten signature. By refusing to complete and sign this section, you agree that no line of credit will be granted to you. If you are human, leave this field blank. Send
